Christopher Middleton/Goldwater
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or dedsion of any commissioner; any action, decision, recommendation of the
City Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the
principal as well as any employee engaged ;n lobbying activities. The term "lobbyists- has specific exduslons. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last)
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BUSINESS NAME AND ADDRESS (Number 1nd Street)
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TELEPHONE NUMBER:
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(City)
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, (State) (Zip Code)
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EMAIL:
FAX NUMBER:
I, LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CUENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) \ (State)\
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(Zip Code)
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TELEPHONE NUMBER:
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FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTI.Y OR INDIRECTI.Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
D. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe In detail):
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any financial, Familial or Professional Relationship
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IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
, A) LOBBYIST DISCLOSURE: (Required) ('PEe; \ brJ f~E') - 01\f~~ tJ; 3t'q p;D FW ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTCOMPENSAllON): (Required). 't>ei\.(ooIN Fee.- ct30~dlJ1) Pb-:f~
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Pursuant to Ordlnana!! No. 2004-3435.
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2)
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Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Otv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaian Finance Reform" Via The Addition Of Code Section 2~8 Entitled "Prohibited
Campaian Contributions BY Lobbvists On Procurement Issues":
Are YOU IobbvlnG on a mesent or oendlna bid for aoods. eaulDrnent or services. or on a Dresent
or oendlnG award for aoods. eaulDment or service?
Pursuant to Ordlnana!! No, 2003-3395 Amendina Miami Beach Cttv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Real Estate Develooment Issues":
Are YOU lobbvlnG on a oendlnG aDDllcation for a DeveloDment AGreement with the City or
aDDllcation for change of zoning maD desiGnation or change to the CitY's Future Land use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDfiURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE fILED EVEN IF THERE HAVE BEEN NO ENDfiURES OR CO SATION DURING THE
REPORTING PERIOD.
I do SOlemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions tained in Section 2- of the Miami Beach City Code and all reporting
requirements,
Signature of Lobbyist:
Signature of Principal/Client:
VI, LOBBYIST IDENTIFICATION:
if; Produced IDmJ/3 -//1-~1-4'/~CI
~~k~ CA Form of Identification
o Personally known (lobbyist)
YD. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
o Produced ID
Form of Identification
f( Personally known (Principal)
Signature of Public Notary - State 0 lorida
Notarization of lobbyist's signature
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Signature of Public Notary - State of Florida
Notarization of Principal's signature